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The Difference between Self-Determination, Capacity, and Competency

The Difference between Self-Determination, Capacity, and Competency
By Kristina James
Published by Ruby

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We humans value our autonomy.

The right to make life decisions for yourself is a hallmark of adulthood, and people are fiercely protective of that right – as they should be!

In some cases, an older person’s mental health can decline to the point at which they lack the ability to be able to make important decisions for themselves.

At this point members of their family, loved ones and friends will start to hear technical terms such as “self-determination”, “capacity” and “competency”. These words are related and are often used interchangeably, but they are still different from one another.


Self Determination

This, essentially, is the right of a person to determine their own destiny.

In the area of medicine (and, for our purposes, elder care), what this really means is that a patient has the right to choose where they live, who they see, what they eat or drink, and anything else to do with how they choose to live their life. It also means that a person has the right to accept or refuse any treatment that is offered to them.

If the person is making choices that somebody else thinks are damaging to their own health, they still have every right to do so.



Capacity is defined as the “ability to understand the nature and effect of one’s acts”. This means that a person understands the choices they are making, and the effect those choices will have on themselves and others.

A person’s “capacity” is something that is determined by a health professional, like a doctor or a nurse, who can do a full evaluation of capacity using specially designed tests. These normally involve asking the person a number of questions such as what month and year it is, who the President of the United States is, can the person count backward from 100 and so on. Other questions determine whether the person understands what is going on around him or her at that time.

These tests run for as long as it takes to determine a person’s capacity, but usually no more than five or ten minutes for experienced medical professionals. They can then decide whether a person has the “sound” mind to, for example, sign a will or a power of attorney.

A particularly tricky thing about capacity is that it can come and go. A person can have the “proper capacity” at one moment but lack it the next. This can be especially difficult when an older person is in the early stages of dementia or Alzheimer’s disease when “good days” and “bad days” can come one after another.



“Competency” is the ability to understand and make decisions about healthcare, finances and other major life events. Judges, rather than medical professionals, make competency determinations, though judges usually rely heavily on the opinions of medical professionals when making their decisions.


Incapacity and Incompetency

Unlike incapacity, which can often be temporary in nature, incompetency is a long-term condition, meaning the person will need another person to handle his or her affairs on a day-to-day basis.

Questions of capacity and competency can be awkward and can make an already tense situation stressful in the extreme. They can even be life-threatening in a medical emergency.


Get ahead of the game.

The best way to avoid these problems is to handle them before they start with completed powers of attorney, healthcare directives and wills in place and ready to go, long before any issues of capacity or competency come up.

In this way, a person will be able to make future major life decisions for themselves while they still have the ability to do so. It will all be there in print, and doctors, judges and family members and friends will have to follow those documents to the letter.

This gives an individual the right to control financial, healthcare and other major decision for their later life, which is exactly what self-determination is all about.

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By Kristina James